EL-19-2967Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
1077 NE 98TH ST, Miami Shores, FL 33138
Contacts
Issue Date:12/27/2019
Parcel Number
1132050180240
Permit NO.: EL-12-19-2967
Permit Type: Electrical - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 06/24/2020
ONE POTATO TWO POTATO LLC Owner ALL FIELDS ELECTRIC, INC Contractor
107798 KEVIN CHATFIELD
Business: 3058285158
Business: 9546806027 CHATKEV@BELLSOUTH.NET
Other: 9546586732
Description: SUPPLY ONE 120 V 20 MP CIRCUIT WITH GFCI FOR Valuation: $ 1,000.00 inspection Requests:
305-e62-4949
FUTURE LANDSCAPE LIGHTING.
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$116.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$116.30
Credit Card
12/27/2019 $116.30
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
d zoning. Futhermore, I authorize the above named contractor to do the work stated.
c
Authorized SignatureVOwner / Applicant / Contractor / Agent
Date
December 27, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
❑BUILDING [Z] ELECTRIC
Miami Shores Village ENTERED
oEc � s 20,9
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 l'1 b
Master Permit No.:E L-' 2-lc( (l
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I O %% A ,)E q 9!S<
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: It -?ACUS� 6(8 O )'g13 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): OAK fa A (V MG e0 l A'7} L(C Phone#: 161 L99' 2 t 2 A
Address: 10 2Nt: S 7—
City: M 18A)� Rt: L& ' State: FL_ Zip:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: /��-•F�� S ;L't7' i � �� � Phone#: (0O �110 X1
Address: `;'i 570 .S CJ 1 6 S A 0-9-
City: SG-) K, )L)C H• S: State: ILL Zip: 55'3
Qualifier Name: Phone#: 9S"I 6S6.7 32
State Certification or Registration #: €'c-- 130o l a a Certificate of Competency #: 1,91 186
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1;1X7d1 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ( ( b 3h
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appAed and a reinspection fee will be charged.
OWNER or AGENT
The foregoin in ment was acknowledged before me this
I S' d of QQC b �_ 20 I , by
fAlh -¢, 6.Q,� SA , who is personally known to
me or who has produced FL PL- 06 20 -`i 33 -?3 as
identification and who did take an oath.
Signature
CONTRA OR
The foregoing instrument was acknowledged before me this
16 day of 20 9 by
K2V IA) C-HA ( Fl e—VMo i ersonally know to
me or who has produced
identification and who did take an oath.
as
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: CoAt Qlku Sign: "
Print: PrIC� Print: C C
Seal: .�� �pATRICICCHATFIELD Seal: lf+ • PATRICKCHATFIELD
MY COMMISSION # GG 109153 MY COMMISSION # GG 109153
1i r E%P : /uigust 26, 2021 •»i EXPIRES: August 26, 2021
'�•: „a• 6ono,.6 1'I+L._Noh_ry Pum unde'wAem Bonded ThNu Notan Public under**=
sssss* s*sssssss*ssssss*s*s*�sssss**s**sss*s**'s**s*ss***ss**s**s*s**s*ss**ss*sss*ss*ss
APPROVED BY �an' `xaminer Zoning
Structural Review
Clerk
(Revised02/24/2014)